consequences of chronic cough Flashcards
What are the pulmonary consequences of chronic cough
Dynamic airway compression in asthma
- expiration is difficults
- so build up of air trapped in alveoli can lead to rupture of visceral pleura
- air enters the pleural cavity and cause a penumothroax
What is a small pneumothorax and what happens
- less than 2 cm
Air enters the pleural cavity from:
- Penetrating injury to parietal pleura
- Rupture of visceral pleura
The Transmural pressure gradient is lost and long recoils towards the lung root and small pneumothorax results
What is a large pneumonthorax and what happens
- More than 2cm (between pareital and visceral pleura)
can occur due to:
- Penetrating injury to parietal pleura
- Rupture of visceral pleura
How is Pneumothorax Diagnosed
- History
- Examination
- > Reduced breath sounds ipsilaterally
- > Reduced ipsilateral chest expansion
-> Hypersonnace on percussion
- Investigation
How to spot a pneumothrax on a CXR
- Abscent lung markings peripherally (opaque lines and blood vessels)
- Lung edge is visible
- tracheal shift
What is a Tension pneumothorax
- one way valve created which permits air entry into pleural cavit on inspiration but cannot exit on expiration
- Intra-pleural pressure is increased with each inspiration
- Collapse on lung towards its root
- Eventaully shift in mediastinal structures
What are 4 divisions of the mediastinum
- Superior - T4
- Inferior - divided into (T7)
- Anterior
- Middle
- Posteiror
What are the consequences of a mediastinal shift
- Tracheal deviation - unilateral pneumothorax
- Superior vena cava compression
- Reduced Venous return to the heart
- Low arterial blood pressure
- Hypoxia, chest pain and dyspnoea
What is the Managment of a large pneumothorax
- Needle aspiration - 2-3rd intercostal space midclavicular line
- Chest Drain
the 4th and 5th intercostal space in the midaxillary line - the safe Triangle
What is the Safe Triangle
- Anterior border of lassimus dorsi
- Posteiror border of pectoralis major
- axial line superior to the nipple
entry into the middle of intercostal spaces due to NVB bundle
Whay is the emergency managment of a Tension penumothroax
- level of rib 2 = sternal anlge
- Midclavicular line
- Guage cannula inserted into pleural cavity via the 2nd and 3rd intercostal spaces
Cannula passes through:
- superficial fascia
- Deep fascia
- 3 layers of intercostal muscles
- Parietal pleura
Other consequences of chronic cough = Herniae
Two factors lead to development
- Weakness of one structure - commonly part of body wall
- Increased pressure on one side of that part of the body wall - due to chronic cough
Herniaes occuring from weekness in one structure
Normal anatomical weakness
- Diaphragm - diaphragmatic herniae
- Umbillicus - umbilical hernia
- Inguinal canal - inguinal hernia
- femoral canal- femoral hernia
Congenital abnormalities
- congenital Diaphragmatic hernia
Surgical scars weakness
- incisional hernia
Where do Diaphragmatic Hernias Develop
- Aortic Hiatus - level of T12
- Normal anatomical weekness at attachments to the xiphoid process
- Inferior Vena Cava -IVC canal opening - T8
- Oesophageal Hiatus - T10
- Normal anatomical weekness posteiror attachments
What is a paraoesophageal Histus Hernia
- Herniated part of the stomach passes through the oesophageal hiatus to become parallel to the Oesophagus and the chest
- Pocket sticks out parallel to the oesophagus